A small area analysis of mortality inequalities in Scotland, 1980-2001

This thesis examines the changing patterns of mortality in Scotland, with particular emphasis on whether there are widening mortality inequalities among small areas in Scotland. The annual number of deaths in Scotland has decreased steadily since the 1950s, yet mortality rates in Scotland are amongst the highest in Europe for many causes. Furthermore, mortality from some causes, such as suicide, has been increasing over time, particularly among young adults. Evidence suggests that inequalities in mortality have widened over time in Scotland, despite substantial investment in policies aimed at reducing inequalities. Therefore, it is important to seek geographical clues that might help explain what causes these high mortality rates. The changing patterns in Scottish mortality between 1980 and 2001 were examined for small areas, created by the author, known as Consistent Areas Through Time (CATTs). These areas have the same boundaries for each census, so that direct comparisons over time are possible. In this study, CATTs have been used to investigate three aspects of the mortality gap in Scotland. First, the widening mortality gaps between 1980-1982 and 1999-2001 are examined for the total population and for premature mortality (<65 years). Second, the influence that geographic scale and deprivation have on the relationship between population change and premature mortality are assessed. Third, suicide inequalities are examined for the younger (15-44 years), older (45+) and total population, using mortality ratios and statistical modelling. The research found that inequalities in premature mortality (<65) have widened for all causes of death studied, particularly for suicide. The negative association between mortality and population change was affected by geographic scale, but this relationship could not be fully explained by deprivation. Small area analyses found that the Highlands and Islands had higher suicide rates than elsewhere in Scotland for males, but not females, when social variables were controlled for

Longitudinal deprivation trajectories and risk of cardiovascular disease in New Zealand

We used longitudinal information on area deprivation status to explore the relationship between residential-deprivation mobility and Cardiovascular Disease (CVD). Data from 2,418,397 individuals who were: enrolled in any Primary Health Organisation within New Zealand (NZ) during at least 1 of 34 calendar quarters between 1st January 2006 and 30th June 2014; aged between 30 and 84 years (inclusive) at the start of the study period; had no prior history of CVD; and had recorded address information were analysed. Including a novel trajectory analysis, our findings suggest that movers are healthier than stayers. The deprivation characteristics of the move have a larger impact on the relative risk of CVD for younger movers than for older movers. For older movers any kind of move is associated with a decreased risk of CVD

Measuring area-level disadvantage in Australia : Development of a locally sensitive indicator

Background In Australia, the Socio-Economic Indexes for Areas (SEIFA), which includes the Index of Relative Socioeconomic Disadvantage (IRSD), captures the socioeconomic characteristics of areas. Because SEIFA rankings are relative to the country or state, the decile categorisations may not reflect an area’s socioeconomic standing relative to areas nearby. Aims The aim of the research was to explore whether IRSD rankings could be re-ranked to become locally sensitive. Data and methods Using existing SEIFA data to redistribute the membership of current decile IRSD groups, we tested three methods to re-rank all SA1 areas relative to the nearest areas capped at: (1) the nearest 99 neighbours, (2) a population threshold of 50,000 (3) a distance threshold of 10 km. Results The reclassification of SEIFA IRSD deciles was largest (up to 8 decile points of change) when comparing the nearest neighbour and population threshold local methods to current state-based rankings. Moreover, compared to using current national and state SEIFA IRSD rankings, the use of local rankings resulted in more evenly distributed deciles between cities, regional, and remote areas. Conclusions Because SEIFA IRSD rankings are used to allocate resources and health services, we encourage the combined use of a state and local ranking to refine areas considered the most disadvantaged

The environment and physical activity: The influence of psychosocial, perceived and built environmental factors

This study sought to integrate perceived and built environmental and individual factors into the Theory of Planned Behavior (TPB) model to better understand adolescents' physical activity

Differences in the risk of cardiovascular disease for movers and stayers in New Zealand: a survival analysis

Objectives: To explore if risk of cardiovascular disease (CVD) for participants who moved before their first CVD event is higher than for stayers, and examine whether the relationship is moderated by ethnicity. Methods: The sample comprised of 2,068,360 New Zealand (NZ) residents enrolled in any Primary Health Organisation, aged between 30-84 years, had complete demographic information, and no prior history of CVD. Cox proportional regression was used to compare CVD risk between movers and stayers. The analysis was conducted for the whole sample and stratified by ethnicity. Results: The combined analysis suggested movers have a lower risk of CVD than stayers. This is consistent for all ethnic groups with some variation according to experience of deprivation change following residential mobility. Conclusions: Although mobile groups may have a higher risk of CVD than immobile groups overall, risk of CVD in the period following a residential mobility event is lower than for stayers. Results are indicative of a short-term healthy migrant effect comparable to that observed for international migrants

Quantifying human movement using the Movn smartphone app: validation and field study

BACKGROUND: The use of embedded smartphone sensors offers opportunities to measure physical activity (PA) and human movement. Big data-which includes billions of digital traces-offers scientists a new lens to examine PA in fine-grained detail and allows us to track people\u27s geocoded movement patterns to determine their interaction with the environment. OBJECTIVE: The objective of this study was to examine the validity of the Movn smartphone app (Moving Analytics) for collecting PA and human movement data. METHODS: The criterion and convergent validity of the Movn smartphone app for estimating energy expenditure (EE) were assessed in both laboratory and free-living settings, compared with indirect calorimetry (criterion reference) and a stand-alone accelerometer that is commonly used in PA research (GT1m, ActiGraph Corp, convergent reference). A supporting cross-validation study assessed the consistency of activity data when collected across different smartphone devices. Global positioning system (GPS) and accelerometer data were integrated with geographical information software to demonstrate the feasibility of geospatial analysis of human movement. RESULTS: A total of 21 participants contributed to linear regression analysis to estimate EE from Movn activity counts (standard error of estimation [SEE]=1.94 kcal/min). The equation was cross-validated in an independent sample (N=42, SEE=1.10 kcal/min). During laboratory-based treadmill exercise, EE from Movn was comparable to calorimetry (bias=0.36 [-0.07 to 0.78] kcal/min, t82=1.66, P=.10) but overestimated as compared with the ActiGraph accelerometer (bias=0.93 [0.58-1.29] kcal/min, t89=5.27, P&lt;.001). The absolute magnitude of criterion biases increased as a function of locomotive speed (F1,4=7.54, P&lt;.001) but was relatively consistent for the convergent comparison (F1,4=1.26, P&lt;.29). Furthermore, 95% limits of agreement were consistent for criterion and convergent biases, and EE from Movn was strongly correlated with both reference measures (criterion r=.91, convergent r=.92, both P&lt;.001). Movn overestimated EE during free-living activities (bias=1.00 [0.98-1.02] kcal/min, t6123=101.49, P&lt;.001), and biases were larger during high-intensity activities (F3,6120=1550.51, P&lt;.001). In addition, 95% limits of agreement for convergent biases were heterogeneous across free-living activity intensity levels, but Movn and ActiGraph measures were strongly correlated (r=.87, P&lt;.001). Integration of GPS and accelerometer data within a geographic information system (GIS) enabled creation of individual temporospatial maps. CONCLUSIONS: The Movn smartphone app can provide valid passive measurement of EE and can enrich these data with contextualizing temporospatial information. Although enhanced understanding of geographic and temporal variation in human movement patterns could inform intervention development, it also presents challenges for data processing and analytics

Cardiac Screening of Young Athletes: a Practical Approach to Sudden Cardiac Death Prevention.

PURPOSE OF REVIEW: We aim to report on the current status of cardiovascular screening of athletes worldwide and review the up-to-date evidence for its efficacy in reducing sudden cardiac death in young athletes. RECENT FINDINGS: A large proportion of sudden cardiac death in young individuals and athletes occurs during rest with sudden arrhythmic death syndrome being recognised as the leading cause. The international recommendations for ECG interpretation have reduced the false-positive ECG rate to 3% and reduced the cost of screening by 25% without compromising the sensitivity to identify serious disease. There are some quality control issues that have been recently identified including the necessity for further training to guide physicians involved in screening young athletes. Improvements in our understanding of young sudden cardiac death and ECG interpretation guideline modification to further differentiate physiological ECG patterns from those that may represent underlying disease have significantly improved the efficacy of screening to levels that may make screening more attractive and feasible to sporting organisations as a complementary strategy to increased availability of automated external defibrillators to reduce the overall burden of young sudden cardiac death